早期诊断及治疗恙虫病的临床价值

The clinical value of early diagnosis and treatment of tsutsugamushi disease

目的分析早期诊断及治疗恙虫病的临床价值及对预后的影响,从而提高临床医院对恙虫病的认识。方法对瑞金市人民医院进5年来诊治的33例恙虫病患者的病例资料进行回顾性分析,重点分析随着对恙虫病诊治时间的延迟,而出现的相对应的临床特征及不同的临床预后。结果恙虫病在每年6~9月高发,33例患者均有野外草地等接触史,均有高热及焦痂、溃疡、淋巴结肿大等症状,其中发热1周内入院的患者16例:无明显脏器损害的3例,单脏器损害的9例(占比56.3%),两脏器损害的3例(18.8%),三及以上脏器损害的1例(6.3%);发热1~2周内入院的患者14例:无明显脏器损害的0例,单脏器损害的4例(占比28.6%),两脏器损害的8例(57.1%),三及以上脏器损害的2例(14.3%);发热2周以上入院的患者3例:无明显脏器损害的0例,单脏器损害的0例(占比0%),两脏器损害的1例(33.3%),三及以上脏器损害的2例(66.7%)。33例病例首诊误诊14例,误诊率42.4%.治愈率为96.9%,仅1例出现多脏器功能衰竭而自动出院。结论恙虫病临床表现比较复杂,随着对恙虫病诊治时间的延迟,出现多脏器损害的概率越大,且损害程度越重,其住院时间越长,预后越不好,造成的经济损失也越大,因此早期诊断及治疗恙虫病的临床价值是重大的。故一线临床医师尤其是卫生院医师及急诊科医师要对恙虫病充分认识,争取对恙虫病能早期诊治,避免误诊及延迟诊治。

Objective To analyze the clinical value of early diagnosis and treatment of tsutsugamushi disease and its impact on prognosis,so as to improve the understanding of tsutsugamushi disease.Methods The people's Hospital of Ruijin city in5years the diagnosis and treatment of33cases of tsutsugamushi disease were analyzed retrospectively,analyzed with tsutsugamushi disease diagnosis and treatment of delayed time,and the clinical features of the corresponding emergence and different clinical prognosis.Results Tsutsugamushi disease incidence in each year from6to September,33patients had wild grass contact history,had high fever and eschar,ulcer,lymph nodes and other symptoms,including16cases of fever within1weeks of admission of the patients:3cases without obvious organ damage,single organ damage in9cases(accounting for56.3%).Two organ damage in3cases(18.8%),1cases of three or more organ damage(6.3%);1to2weeks of fever patients hospitalized in14cases:0cases had no obvious organ damage,single organ damage in4cases(accounting for28.6%),two of the8cases of organ damage(57.1%).2cases of three or more organ damage(14.3%);3cases of fever over2weeks hospitalized patients:0cases without obvious organ damage,single organ damage in0cases(accounting for0%),two of the1cases of organ damage(33.3%),2cases of three or more organ damage(66.7%).33cases were misdiagnosed in the first diagnosis,the misdiagnosis rate of42.4%.was96.9%,only in the case of multiple organ failure in1cases and was discharged automatical ly.Conclusion the clinical manifestation of tsutsugamushi disease complicated with tsutsugamushi disease diagnosis and treatment of delayed time,the probability of occurrence of multiple organ damage is greater and greater damage,the more time of hospitalization,the prognosis is not good,the economic loss caused by the larger,so the clinical value of early diagnosis and treatment of tsutsugamushi disease is significant.Therefore,first-line clinicians,especially doctors and emergency department physicians should fully understand the tsutsugamushi disease,for early diagnosis and treatment of scrub typhus,to avoid misdiagnosis and delayed diagnosis and treatment.